The most common form of malignancy that affects children is childhood leukemia. It affects more than 3,000 children in the United States alone every year [1, 2].
What is Childhood Leukemia?
The condition leukemia is known as the cancer of white blood cells. These cells, along with other blood cells, are produced in the bone marrow. In leukemia, the bone marrow is unable to produce mature WBCs. These immature cells are unable to fight infection like the mature ones. These cells rapidly accumulate and proliferate in the bone marrow and crowd out the healthy cells. As the leukemia cells continue to divide and spread to other organs [3, 4].
Types
There are several types of leukemia in children and majority of them are acute. They differ in the type of immature blood cells that the bone marrow produces [1, 4].
Acute lymphoblastic leukemia
This is also known as acute lymphocytic leukemia. It is the most common type of leukemia found in children and accounts for about 75% of all total cases [1, 4].
Acute myelogenous leukemia
AML is the next most common type of leukemia in children [1, 4].
Hybrid or mixed lineage leukemia
This rarely occurring kind of leukemia possess the characteristics of both ALL and AML [1, 4].
Chronic myelogenous leukemia – CML is the chronic variation of AML and is mostly seen in adults [1, 4].
Chronic lymphocytic leukemia – It is the slow-progressing variation of the ALL. This condition is commonly seen in adults and rarely occurs in children [1, 4].
Juvenile myelomonocytic leukemia – This type of leukemia do not classify as acute or chronic. It is rarely occurring and mostly develop in children who are under 4 years of age [1, 4].
Causes
The development of leukemia is linked to chromosomal translocation. In this event, a segment of one of the arms of chromosomes breaks off and attaches to another one. This will result to an error in gene expression and may lead to the production of immature blood cells. These cells does not have the traits of normal blood cells and will continue to divide [5].
Risk Factors
Risk factors may increase the likelihood of leukemia developing in a child. Having a sibling or twin that have develop leukemia have higher than average risk of having the same condition. Those who have acquired genetic conditions such as Down syndrome, neurofibromatosis, Li-Fraumeni syndrome or Fanconi’s anemia are at an increased risk as well [4].
Children who have underwent previous chemotherapy or radiation therapy for a different type of cancer have a higher chance of developing the disease. A higher risk is also present in those who are receiving drugs that suppress the immune system after an organ transplant [4].
Signs and Symptoms
The signs and symptoms of childhood leukemia is similar to that of other diseases. They develop gradually but there are patients who do not present with any symptoms at all. Some of these children may bruise easily or develop pinpoint red spots under their skin [1, 2, 4].
Accumulation of immature white blood cells in the spleen may cause it to increase its size. The enlargement may cause some pain or fullness below the ribs in the left side of the abdomen. This type of symptom may be felt by the physician during the physical examination [1, 2, 4].
White blood cells play an important role in fighting off infection but this role could not be fulfilled by immature blood cells. This will result in frequent infection and appearance of fever, coughing and runny nose. Oftentimes, these infections do not improve with the use of antibiotic agents [1, 2, 4].
Diagnosis
Health history and physical examination
Information included in the health history include the symptoms that are experienced, family health history, allergies and current medications that the child is taking. The physical examination will include looking for sites of abnormal bleeding, anemia, signs of infection, swollen lymph nodes and the presence of enlarged spleen [1, 4].
Complete blood count and peripheral blood smear
A complete blood count will tell the number of RBCs, WBCs and platelets in the blood. The blood smear will show the presence of abnormal blood cells in the blood. Patients with leukemia will have specific types of immature blood cells in their blood sample [1, 4].
Bone marrow aspiration and biopsy
Leukemia cells proliferate and accumulate in the bone marrow. Analysis of the bone marrow of a patient with leukemia will show a large number of specific types of leukemia cells. The common collection sites for bone marrow aspiration are the breastbone or the hipbone [1, 4].
Treatment
The treatment for childhood leukemia is done by a team of specialists and the method that will be used will depend on the age of the patient and the white blood count at the beginning of the treatment. A patient who have complied with the therapeutic regimen have a good prognosis. The remission rate for childhood leukemia is high with some types reaching 90% [1, 3, 4, 5].
Chemotherapy
This use of chemotherapeutic drugs is the primary way of treating leukemia. These drugs may be given to the patient orally, intravenously or through the spinal fluid. There are several side effects that are associated with this type of treatment. Examples of these side effects are hair loss, vomiting, nausea and increased risk for infection. These symptoms are managed as they appear on the patient [1, 3, 4, 5].
Other treatment types
Aside from chemotherapy, the patient may undergo radiation therapy, targeted therapy and transplant of stem cells. These methods may be done in combination with chemotherapy to ensure that all cancer cells are eliminated from the body [1, 3, 4, 5].
Prognosis and Survival Rate
Survival rate of children diagnosed with childhood leukemia has improved significantly from 1990 to 2005. The rate climbed from 83.7% in 1990 and became 90.4% in 2005. This is attributed to the development of drugs that were able to treat childhood leukemia. This has been a significant improvement because during the 1960’s the 5-year survival rate of children with this condition were just 10%.
Factors that may affect the prognosis of the patient are looked into by the physician to see the most appropriate treatment for the patient. Some of these factors are the preliminary white blood count, age of patient at the time of the diagnosis, possible spread to adjacent or distant organs, the number of chromosomes of the leukemic cells and the patient’s response to the treatment.
References
- Movva, S. (2015, July 26). Childhood Leukemia. Retrieved from WebMD: http://www.webmd.com/cancer/lymphoma/childhood-leukemia-symptoms-treatments
- Pietrangelo, A. (2014, February 26). 7 Important Symptoms of Leukemia in Children. Retrieved from Healthline: http://www.healthline.com/health/symptoms-leukemia-children#Overview1
- Medline Plus. (2016, May 20). Childhood Leukemia. Retrieved from Medline Plus: https://www.nlm.nih.gov/medlineplus/childhoodleukemia.html
- Ben-Joseph, E. P. (2014, January). Childhood Cancer: Leukemia. Retrieved from Kid’s Health: http://kidshealth.org/en/parents/cancer-leukemia.html#
- Borton, C. (2013, May 13). Childhood Leukaemias. Retrieved from Patient: http://patient.info/doctor/childhood-leukaemias
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